Defying the Odds: Successful surgical management of a rare intrapelvic sacrococcygeal teratoma in Eastern Uganda

Sacrococcygeal teratomas (SCTs) are the most common congenital tumours in neonates, typically presenting as external masses at birth. We present a rare case of a predominantly intrapelvic SCT in a one-month-old female infant from rural eastern Uganda. The child was referred with a progressively enlarging sacrococcygeal mass that caused anal deviation and difficulty in defecation. Clinical evaluation and imaging suggested a presacral mass without distant spread. Surgical exploration via a posterior sagittal approach revealed a solid intrapelvic tumour tightly adherent to the posterior rectal wall and coccyx. Complete excision of the mass, including coccygectomy, was successfully performed without injury to adjacent structures. Histopathology confirmed a mature sacrococcygeal teratoma. Postoperative recovery was uneventful, and follow-up showed no signs of recurrence or functional impairment. This case underscores the importance of early recognition of SCTs, even in atypical presentations without external components. It also reinforces the surgical principle that complete resection with coccygectomy is essential to reduce the risk of recurrence. Despite the challenges of a low-resource rural setting, this case illustrates that successful management of complex congenital tumours is achievable with timely intervention and appropriate surgical planning.